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Re: denials

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In a message dated 12/18/2003 12:51:05 PM Pacific Standard Time,

screenok@... writes:

> My question is: If you go through the 3 appeals and then through the

> state review and lose, does that mean you can never file for the

> surgery again? Or is there a waiting period before you can try again?

> Barbara

Hi Barbara,

I don't know that this always happens, but in my case, I switched doctors and

started all over again and got my approval first try. I don't know the legal

ins and outs of it, though.

Hugs and blessings, Ann

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On Thu, 18 Dec 2003 20:40:07 -0000, screenok wrote:

>My question is: If you go through the 3 appeals and then through the

>state review and lose, does that mean you can never file for the

>surgery again? Or is there a waiting period before you can try again?

>Barbara

>

Barbara,

As far as I know, as long as you have additional information that has a

bearing on your case, you can resubmit to the state at any time. Also,

even if the state denies you, you still have the option of hiring a lawyer

and taking your case to court. At least that's what I remember about the

CA system. However, there is one exception, if you are covered by the

federal health benifits program, i.e. either you or the primary insured is

a federal employee, then you have to appeal to OPM with a last resort of

filing with the federal courts.

Hope that helps,

Jerry

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